If you have watched movies or dramas depicting people going breathless or having breathing difficulty, you may be familiar to see these patients are given oxygen masks to help them breathe. If you watch enough medical themed entertainment or maybe you have witnessed this yourself, you may see doctors poking the chest area to help patients breathe. In this DoctorOnCall’s article, we will learn more about thoracentesis, a medical procedure commonly done in both clinical and emergency settings.
Thoracentesis is a medical procedure that is done to remove fluid or air from the space around the lungs, also known as the pleural space. The fluid that is found within the pleural space should only be a thin layer between the lungs and the chest wall. It is said that the fluid should only be around 4 teaspoons, which helps the membrane surrounding the pleura from rubbing together as a person breathes. Thus, thoracentesis is a procedure that removes the excess fluid or to obtain the fluid for sample purpose. Beside fluid that is removed, thoracentesis also removes air that causes lungs unable to expand normally.
Thoracentesis is also known as pleural tap. You will see that thoracentesis is often used in treating patients with pleural effusion or pneumothorax. Pleural effusion is the excess fluid in the pleural space that can be caused by many conditions, commonly congestive heart failure, pneumonia and cancer. Pneumothorax is a collection of air outside of the lung and within the pleural cavity. Pneumothorax is usually caused by chest injury or medical procedure. Both of these conditions cause similar symptoms which is breathing difficulty. Thus, pleural tap helps to ease symptoms by enabling patients to breathe better. Beside helping patients to ease breathing symptoms, thoracentesis is used in diagnosing certain conditions by taking samples. For example, thoracentesis in small volume can help identify infection or underlying conditions that cause fluid buildup. In cases where the volume of fluid is expected to reaccumulate quickly, drain is often left in place to help collect this fluid.
Before thoracentesis is performed, health professionals will provide instructions on how to prepare for the procedure such as what medication that should be stopped before the day of the procedure and if patients are allowed to eat or drink before the procedure. Imaging tests such as x-ray is done to evaluate the lungs before thoracentesis. Ultrasound guidance may also be used during the procedure to help pinpoint the best site to do thoracentesis. Sedatives may be given in younger children but adult or older children are typically awake during the thoracentesis procedure.
Patients should notify their doctor if they are taking medication, particularly blood clotting medication such as warfarin as this may need doctors to provide specific medication prior the procedure. Patients may also want to ensure they have someone to drive them home after the procedure.
Thoracentesis starts when a health professional disinfects the skin where needles will be placed in. Anaesthetic medications are injected on the skin before a needle is inserted to drain the fluid. It is important to follow instructions on when to inhale or exhale or even hold breath throughout the procedure. The needle may be connected to a collecting tube to collect fluid. Needle will be removed and the area will be covered with bandages. The procedure typically takes around 10 to 15 minutes but may be longer if the amount of fluid removed is large. Patients are advised to avoid strenuous activity for a couple of days but are able to resume with their daily life routine when patients are able to carry on. X-ray may be taken after the procedure to ensure thoracentesis is considered successful.
Similar to any medical procedure, specifically invasive one such as with thoracentesis, there are possible complications that can occur following the procedure. The 4 complications of thoracentesis are bleeding, pain, infection and damages or punctured structures such as nerve, spleen or liver. Hemothorax could occur as a complication but it is rare. Pneumothorax may also be resulted from thoracentesis but usage of ultrasound is able to reduce the likelihood of such an event. To avoid complications, patients need to follow all instructions by the health professionals. If a patient starts to experience fever, feeling short of breath, breathing difficulties, chest pain, leaking from the needle site and swelling or redness at the needle site, the patient needs to tell their healthcare provider as this could be signs of an ongoing serious condition.
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It can be concluded that thoracentesis is a procedure that removes air or fluid from the pleural space. It can be done either as a treatment in those with breathing difficulties or as a way to obtain samples in helping diagnose conditions that cause accumulation fluid in the pleural space. The procedure itself is considered brief but may be longer in severe cases and not considered as a surgical procedure as it is not done in an operation room or theatre.
